Journal article
Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries
Critical care (London, England), Vol.22(1), pp.195-195
08/17/2018
DOI: 10.1186/s13054-018-2126-6
PMCID: PMC6097245
PMID: 30115127
Abstract
Background: To better understand the epidemiology and patterns of tracheostomy practice for patients with acute respiratory distress syndrome (ARDS), we investigated the current usage of tracheostomy in patients with ARDS recruited into the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG-SAFE) study.
Methods: This is a secondary analysis of LUNG-SAFE, an international, multicenter, prospective cohort study of patients receiving invasive or noninvasive ventilation in 50 countries spanning 5 continents. The study was carried out over 4 weeks consecutively in the winter of 2014, and 459 ICUs participated. We evaluated the clinical characteristics, management and outcomes of patients that received tracheostomy, in the cohort of patients that developed ARDS on day 1-2 of acute hypoxemic respiratory failure, and in a subsequent propensity-matched cohort.
Results: Of the 2377 patients with ARDS that fulfilled the inclusion criteria, 309 (13.0%) underwent tracheostomy during their ICU stay. Patients from high-income European countries (n = 198/1263) more frequently underwent tracheostomy compared to patients from non-European high-income countries (n = 63/649) or patients from middle-income countries (n = 48/465). Only 86/309 (27.8%) underwent tracheostomy on or before day 7, while the median timing of tracheostomy was 14 (Q1-Q3, 7-21) days after onset of ARDS. In the subsample matched by propensity score, ICU and hospital stay were longer in patients with tracheostomy. While patients with tracheostomy had the highest survival probability, there was no difference in 60-day or 90-day mortality in either the patient subgroup that survived for at least 5 days in ICU, or in the propensity-matched subsample.
Conclusions: Most patients that receive tracheostomy do so after the first week of critical illness. Tracheostomy may prolong patient survival but does not reduce 60-day or 90-day mortality.
Details
- Title: Subtitle
- Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries
- Creators
- Toshikazu Abe - Juntendo UniversityFabiana Madotto - University of Milano-BicoccaTai Pham - University of TorontoIsao Nagata - University of TsukubaMasatoshi Uchida - University of TsukubaNanako Tamiya - University of TsukubaKiyoyasu Kurahashi - International University of Health and WelfareGiacomo Bellani - University of Milano-BicoccaJohn G. Laffey - University of TorontoLUNG SAFE InvestigatorsEuropean Society of Intensive Care Medicine (ESICM) Trials Group
- Contributors
- Nicholas M Mohr (Contributor) - University of Iowa, Anesthesia
- Resource Type
- Journal article
- Publication Details
- Critical care (London, England), Vol.22(1), pp.195-195
- DOI
- 10.1186/s13054-018-2126-6
- PMID
- 30115127
- PMCID
- PMC6097245
- NLM abbreviation
- Crit Care
- ISSN
- 1466-609X
- eISSN
- 1466-609X
- Publisher
- Springer Nature
- Number of pages
- 16
- Grant note
- St Michael's Hospital, Toronto, Canada JP 16 K15388 / JSPS KAKENHI, Japan; Ministry of Education, Culture, Sports, Science and Technology, Japan (MEXT); Japan Society for the Promotion of Science; Grants-in-Aid for Scientific Research (KAKENHI) European Society of Intensive Care Medicine (ESICM), Brussels, Belgium University of Milan-Bicocca, Monza, Italy
- Language
- English
- Date published
- 08/17/2018
- Academic Unit
- Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
- Record Identifier
- 9984295922502771
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